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This leaflet is designed to tell you about stomas that produce large amounts of fluid, why this may have happened and changes to your diet that may help you manage this.
What is a stoma and what is a high output?
A stoma is a surgically created opening which connects part of your bowel to the outside of your body. It is created when some or all of the small or large intestine is removed. The area affected depends on your diagnosis and the surgery performed. The created stoma becomes the route to allowing waste products including stools or faeces to exit your body, this is usually referred to as output. A high output stoma produces a large amount or watery stool, usually more than 1000ml in 24hrs.
Problems with a high output stoma?
The function of the large intestine is to absorb water and salt from the stools, so when some or all of this is removed the stool can be of a higher volume and more watery.
The small intestine absorbs digested food so when some or all of this part of the bowel is removed it is often much harder to absorb nutrients from the foods that you eat.
If a higher output stoma is not managed correctly you will be at risk of developing nutritional deficiencies and dehydration.
How to reduce a high stoma output?
The following page contains advice that will help to maximise the amount of nutrients you can absorb from food and reduce the output of your stoma. This advice may change as your bowel adapts over time and your stoma output varies.
- Eat slowly and chew foods well.
- Eat regularly to make sure you have a regular output and prevent excessive wind.
- Eating very small meals, but more frequently may help to stop you from feeling bloated and increase the absorption of nutrients.
- Avoid eating and drinking at the same time as this may cause wind and bloating.
- Your doctor, dietitian or stoma nurse may suggest you restrict your fluids to a certain amount per day.
- Your doctor may prescribe medication to slow down your bowels e.g. loperamide, (you should speak to your doctor or a pharmacist regarding the best timings to take this in relation to your meals).
What can I eat?
| Food and Drinks to include regularly | Effect on output | |
| Protein foods | Smooth peanut butter, cheese, fish, chicken, turkey, eggs, finely chopped meat e.g. mince milk, cheese and yoghurt | Slow the movement of food through your intestines giving your body more time to digest them. |
| Starchy foods | White bread, pasta (not wholemeal), white or basmati rice, cous-cous, chapattis, potato, yam, plantain, Rice Krispies®, Weetabix®, oats, cornflakes, maize based meals, millet, cornmeal, plain biscuits, and crackers. | Easier for your intestine to absorb and thicken output. |
| Fruit | Apple sauce, banana, melon, tinned peaches/pears in natural juice (ensure all pith and peel are removed and avoid large portions at a time). | Help to thicken stool and decrease output. Will provide essential vitamins and minerals. Try to have 5 portions of fruit and vegetables every day. |
| Vegetables | Well-cooked and peeled root vegetables e.g. carrots/swede/parsnips. | Provide vitamins and minerals without increasing output. |
| Drinks | Isotonic drinks e.g. Lucozade Sport®, Poweraid® | May help to absorb more fluid and electrolytes which can help to reduce stoma output. |
| Desserts | Marshmallows, tapioca, jelly, custard | Will provide calories and without increasing output. If on a fluid restriction you may need to count liquid foods e.g. jelly in your limit. |
| Salty foods | Add extra salt to your meals and include salty foods such as crisps, pretzels, instant soup, gravy, smoked/canned fish, smoked bacon, or Bovril®. | To help replace salt lost in stoma output and to help absorb fluids. However, salt should be decreased again as your bowels improve to help maintain your heart health. |
What can’t I eat?
| Food and Drinks to avoid | Effect on output | |
| Protein foods | Large pieces of red meat like steak, pork chops, roasted joints etc. Eggs | These are often hard to digest and may cause boating or indigestion. May cause increased gas production if eaten in high quantities. |
| Starchy foods | Wholegrain foods for example, brown/wholemeal bread, wholemeal pasta and brown rice, wholegrain breakfast cereals like Shredded Wheat®, mueslis and Ryvita® | These types of food can increase cramping and bloating symptoms. Individuals that are very sensitive to the effects of fibre may find that even small amounts of these sorts of food will cause increased stoma output. |
| Fruit | Anything with skins, pips and seeds e.g., berry fruits. Stringy fruits like rhubarb, coconut, and dried fruits. | These can increase output and may cause an obstruction or blockage. |
| Vegetables | Tough fibrous vegetables and foods with tough shells e.g., peas, sweetcorn, popcorn, beans, celery, mushrooms, nuts. | Gas producing vegetables e.g., cauliflower, broccoli, cabbage, sprouts, onions, garlic, spinach, mushrooms. These can cause increased output and excessive wind. Husky, fibrous, and stringy vegetables and nuts may increase risks of a blockage. |
| Drinks | Large amounts of fruit juices (including apple or grape juice), caffeinated drinks, alcoholic drinks, fizzy drinks. | These may all cause increased output and lead to dehydration. Fizzy drinks can also increase gas production. |
| Other | Spicy and fatty/greasy foods | Can increase output. |
Fluid and hydration
If your output is very high (more than 1.5L/day), doctors may recommend that you only drink an oral rehydration solution (sometimes called St Marks Solution or Oxford rehydration solution), you can find the recipes for this below.
This drink will help to rehydrate you, replace any electrolytes you may be losing in your output and reduce your stoma output. It is important that you make up the recipe exactly and DO NOT USE substitute ingredients. A small amount of cordial can be added for flavour and you may find you tolerate it better if it is served chilled.
Rehydration solution recipes
St Marks Solution:
20g (6 heaped teaspoons) glucose powder (not sugar)
2.5g (1/2 heaped teaspoons) sodium bicarbonate
Made to 1 litre with water.
3.5g (1 level teaspoon) salt
Oxford rehydration solution:
200mls squash (not low in sugar)
800mls water
3.5g (1 level teaspoon) salt
These solutions may affect blood sugar levels if you have diabetes. These should be closely monitored, if you have any questions these should be discussed with your diabetes specialist nurse.
Details of other organisations that can help:
- Stoma advice line at Milton Keynes Hospital (stoma nurses): 01908 996 951.
- For specific information on ileostomies or colostomies see the NHS choices website
- IA (the ileostomy and internal pouch support group): http://www.iasupport.org/
